Page 25 - Delaware Medical Journal - January/February 2020
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ABSTRACTS
Update on ‘Impact of Right Ventricular Systolic Dysfunction on Post-Cardiac Surgery Outcomes in Patients with LV Systolic Dysfunction’
Sourin Banerji, MD; Jennifer Goldstein, MD, MSc
Sourin Banerji, MD; Jennifer Goldstein, MD, MSc; Dhara Shah, DO; Robert DeGrazia, MD
Background & Objectives: Mortality among patients undergoing surgery is worse in those with left ventricular (LV) systolic dysfunction.1,2 However, the impact of right ventricular (RV) systolic dysfunction on morbidity and mortality is less clear. Using echocardiogram parameters including TAPSE (tricuspid annular plane systolic excursion) to assess RV function, we plan to understand the association of RV function with postoperative outcomes in patients with concomitant LV systolic dysfunction.
Methods: Bridging the Divides (Bridges)
is a care management program at ChristianaCare focused on helping patients with ischemic heart disease transition successfully from hospital care. Using
data from this program, a retrospective observational study was designed. Our inclusion criteria included patients who underwent CABG (coronary artery bypass underwent a pre-operative echocardiogram within one year of cardiac surgery. Patients with LVEF > 40% were excluded. Notably, the study does not focus on the nature of
the cardiac surgery, i.e. number of bypasses performed, concomitant valve replacements, parameters to assess RV function will include size, qualitative function, TAPSE, time integral (RVOT VTI). The dependent (predictor) variable will be biventricular
dysfunction. The primary independent (outcome) variable will be mortality at 30 and 60 days. Secondary outcome variables include total hospital and ICU length of stay, duration of mechanical ventilation, intra-aortic balloon pump requirement, and duration of inotropic and vasopressor requirements among many others.
Proposed Analyses: Patients will be divided into two groups: LV dysfunction versus LV and RV dysfunction (biventricular dysfunction). Frequencies and means will be calculated for all variables mentioned above. We will use multivariable linear regression
to determine the independent association between biventricular failure and 30-day mortality, adjusting for variables known to be associated with increased mortality.
Conclusion: We hypothesize that biventricular dysfunction will negatively impact a patient’s mortality and morbidity in the postoperative setting. If true, pre- operative risk assessment and management
CONTRIBUTORS
■ Mohammad Beizaeipour, DO is completing his final year of Internal Medicine residency at ChristianaCare. His interests include cardiovascular disease and he is actively participating in a number of cardiac-related research projects. He has contributed to a number of publications.
REFERENCES
■ Sourin Banerji, MD is a cardiologist specializing in congestive heart failure at ChristianaCare. He is board-certified in internal medicine and cardiovascular disease, with specialty certification in advanced
heart failure and transplant cardiology by the American Board of Internal Medicine. Dr. Banerji has contributed to publications and engaged in cardiac/heart research as a co- and principal investigator at Albert Einstein Medical Center, the University of Pennsylvania, and during his undergraduate studies at the University of California. He
is a member of the Heart Failure Society
of America, International Society of Heart and Lung Transplantation, and the American College of Cardiology.
■ Jennifer N. Goldstein, MD, MSc is the Co-Director of the Resident Research Training Program at ChristianaCare and the Program Director for Clinical Research Education
at the Value Institute. She practices as a hospitalist for Christiana Care Hospitalist Partners.
■ Dhara Shah, DO is a Cardiology Fellow
at ChristianaCare, where she completed
her Internal Medicine Residency. She has participated in a number of publications and her area of interest focuses on general and preventative cardiology as well as heart failure.
■ Robert DeGrazia, MD is the current Internal Medicine Chief Resident at ChristianaCare, where he also completed his residency. He
is interested in pursuing a General Internal Medicine Fellowship at the completion of his chief year.
1. Healy KO, Waksmonski CA, Altman RK, Stetson PD, Reyentovich A, Maurer MS. Perioperative Outcome and Long-Term Mortality for Heart Failure Patients Undergoing Intermediate-and High-Risk Noncardiac Surgery: Impact of Left Ventricular
Ejection Fraction. Congest Heart Fail. 2010;16(2):45–49. doi:10.1111/j.1751- 7133.2009.00130.x. Perioperative.
2. Fleisher LA, Fleischmann KE, Auerbach AD, et al. 2014 ACC/AHA Guidelines
on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery: A Report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;64(22):e77-e137. doi:10.1016/j.jacc.2014.07.944.
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